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Dysphagia is one of the postoperative complications of cervical degenerative disorders. However, few studies have evaluated the pre- and postoperative swallowing function in detail.To analyze pre- and postoperative swallowing dynamics kinetically and investigate factors associated with postoperative dysphagia in patients with cervical degenerative disorders.Retrospective review of prospectively collected data.A total of 41 consecutive patients who underwent an anterior approach (anterior cervical discectomy/corpectomy and fusion (ACDF, ACCF), hybrid surgery (ACDF+ACCF) and total disc replacement) and 44 consecutive patients who underwent a posterior approach (laminoplasty and laminoplasty/laminectomy with fusion).We compared the pre- and postoperative functional oral intake scale (FOIS), dysphagia severity scale (DSS), esophageal dysphagia, anterior/superior hyoid movement, upper esophageal sphincter (UES) opening, pharyngeal transit time, bolus residue scale (BRS), and the number of swallows.Videofluoroscopy was performed on the day before surgery and within two weeks after surgery. Data related to age, gender, disease, surgical procedure, surgical site, operative time, and blood loss were collected from the medical records. Pre- and postoperative data were compared for each item in the anterior and posterior approaches. The odds ratio of dysphagia after an anterior approach was also calculated.In the anterior approach, DSS, FOIS, the anterior and superior hyoid movements, maximum UES opening, BRS, and number of swallows worsened postoperatively (p.05, respectively). In the posterior approach, DSS, FOIS, the anterior hyoid movement, and BRS worsened postoperatively (p.05, respectively). The factors associated with dysphagia were a proximal surgical site above C3 (OR: 14.40, CI: 2.84-73.02), blood loss100 ml (OR: 9.60, CI: 2.06-44.74), an operative time200 min (OR: 8.18, CI: 1.51-44.49), and an extensive surgical field of more than three intervertebral levels (OR: 6.72, CI: 1.50-30.07). The decline in swallowing function after the posterior approach was related to aging (p = .045).Each approach may decrease swallowing function, especially because of the limitation on the anterior hyoid movement. Dysphagia after anterior approaches was associated with the operative site, operative time, and blood loss.

Introduction: There are various doses, durations, and strains of bacillus Calmette-Guérin (BCG) intravesical instillation therapy, but optimal treatment has not yet been established. We retrospectively investigated the efficacy and safety of low-dose BCG therapy for non-muscle-invasive bladder cancer (NMIBC) and carcinoma in situ (CIS) in a multicenter study. Methods: From 1991 to 2019, 323 patients who received BCG therapy to prevent recurrence of NMIBC were analyzed as group A. Similarly, 147 patients who received BCG therapy for the treatment of CIS were analyzed as group B. Patients received low- or full-dose Tokyo-172 strain or full-dose Connaught strain, and the three strains were compared. Survival curves were estimated by the Kaplan-Meier method, and independent risk factors for intravesical recurrence were examined by multivariate logistic regression. Results: Recurrence-free survival (RFS) in group A was significantly better for the Connaught strain than the low-dose Tokyo-172 strain (p = 0.026), but not between the low- and full-dose Tokyo-172 strains (p = 0.443). RFS of group B, cancer-specific survival, and progression-free survival in both groups did not show statistically significant differences. Logistic analysis of group A showed that for intravesical recurrence, only pT1 was a significant risk factor, and there were no differences between the BCG strain and dose and no significant factors in group B. There were also no differences in the completion rate in both groups, but adverse events such as urinary frequency and feeling of residual urine were significantly lower with the low-dose Tokyo-172 strain. Conclusion: There was no difference in efficacy between the low- and full-dose Tokyo-172 strains, but to minimize adverse events, the low-dose Tokyo-172 strain may be worth considering.

The study aimed to evaluate the influence of the manipulation surfaces on the physical properties of one-step self-etch adhesives (1-SEAs). Scotchbond Universal (SBU), Clearfil Universal Bond Quick ER (UBQ), and an experimental adhesive (UBQexp) were manipulated on different surfaces: manufacturer’s Teflon-based dispensing dish (TD) or hydroxyapatite plate (HA). After manipulation of the adhesives, the pH of each 1-SEA was measured. Samples of each adhesive/manipulation surface were prepared and subjected to water sorption (WS)/solubility (SL) and flexural strength tests. The modulus of elasticity (E) was measured in dry and wet conditions before and after 24 h water storage, and the percentage of variation of E (ΔE) was calculated. Results were analyzed using the t-test with Bonferroni corrections (α = 0.05). When adhesives were manipulated on the HA plate, there was a significant increase in the adhesives’ pH. WS and SL of all 1-SEAs decreased when the HA was used. Only SBU showed higher flexural strength when manipulated on the HA compared to the manipulation on TD under dry and wet conditions. For each 1-SEA, the use of HA resulted in significantly higher E in dry and wet conditions. ΔE of all adhesives was smaller with the manipulation on HA than on TD. It was concluded that the manipulation of 1-SEA on a hydroxyapatite plate considerably affected the adhesives’ properties.

An investigation of alternatives to immune checkpoint inhibitors for advanced urothelial cancer (aUC), with biologic information, is urgently needed. Clinical data for 53 patients who received gemcitabine–paclitaxel therapy (GP) as 2nd-line chemotherapy for aUC refractory to platinum-based chemotherapy were retrospectively reviewed. The efficacy and tolerability of GP were evaluated, and the predictive value of phosphoglycerate kinase 1 (PGK1) immunostained in surgical specimens was investigated for treatment outcomes in 1st- and 2nd-line chemotherapy. GP was associated with an objective response rate of 35.8% and a median overall survival duration of 12.3 months. Multivariate analysis showed that PS2 and 1st- and 2nd-line non-response are independent predictors of worse progression-free survival and that PS2 and 1st-line non-response are independent predictors of worse overall survival. Adverse events were manageable, and no therapy-related deaths occurred. Non-response rates to 1st-line chemotherapy were significantly higher in patients with a high expression of PGK1 in the nucleus than in those with low expression (p = 0.006). Our study demonstrates the efficacy and tolerability of 2nd-line GP for patients with aUC who are refractory to platinum-based chemotherapy. Moreover, PGK1 in the nucleus was predictive values for resistance to platinum-based chemotherapy in aUC.

This study aimed to evaluate the bonding abilities and long-term durability of different repair agents when applied to lithium disilicate ceramics (LDS). Blocks of IPS e.max CAD were prepared and divided into four groups according to the surface treatment: Monobond EtchPrime (ME), K-etchant GEL+Clearfil Universal Bond (UB), Bondmer Lightless (BL), and K-etchant GEL+G-Multi Primer (GMP). All treated ceramic specimens were bonded to resin composite and light-cured. The micro-shear bond strength was measured after 24 h of water storage or 5,000 thermocycles. ME and BL showed significantly higher initial bond strengths than UB and GMP (p0.05). After 5,000 thermocycles, there was no significant difference in ME (p0.05), but BL and GMP showed considerable reduction in bond strength (p0.05); moreover, the samples of UB were all de-bonded before testing. ME and BL proved to be effective surface treatment materials for LDS.

Early detection of primary bladder cancer (BCa) is vital, because stage and grade have been generally accepted not only as categorical but also as prognostic factors in patients with BCa. The widely accepted screening methods for BCa, cystoscopy and urine cytology, have unsatisfactory diagnostic accuracy, with high rates of false negatives, especially for flat-type BCa with cystoscopy and for low-risk disease with urine cytology. Currently, liquid biopsy has attracted much attention as being compensatory for that limited diagnostic power. In this review, we survey the literature on liquid biopsy for the detection of BCa, focusing on circulating tumor cells (CTCs), urinary cell-free DNA (ucfDNA), and urinary microRNA (umiRNA). In diagnostic terms, CTCs and umiRNA are determined by quantitative analysis, and ucfDNA relies on finding genetic and epigenetic changes. The ideal biomarkers should be highly sensitive in detecting BCa. Currently, CTCs produce an unfavorable result; however, umiRNA and ucfDNA, especially when analyzed using a panel of genes, produce promising results. However, given the small cohort size in most studies, no conclusions can yet be drawn about liquid biopsy’s immediate application to clinical practice. Further large studies to validate the diagnostic value of liquid biopsy for clinical use are mandatory.

This study aimed to assess the influence of different light curing units (LCUs) on the polymerization of various flowable resin composites. Three LCUs (Optilux 501, Elipar™ DeepCure-L LED and Bluephase®20i) and eight flowable resin composites: MI FIL Flow, Estelite Flow Quick, Estelite Universal Flow (medium), Estelite Universal Flow (super low), Beautifil Flow Plus, Clearfil Majesty ES Flow, Filtek Supreme Ultra flowable and TetricEvo Flow were tested. For Vickers microhardness (VHN) test and degree of conversion (DC), specimens were prepared and polymerized for 20 s. VHN test was performed at top surfaces (3 indentations) and DC for each specimen was measured using Fourier transform infrared (FT-IR) spectroscopy after 24 h dry storage in dark at 37˚C. The data were analyzed with 2-way ANOVA and t-test with Bonferroni correction. DC and hardness values showed a relationship between materials and LCUs. The curing efficacy of LCU type may depend on the material composition.

Background There is a high incidence of intravesical recurrence after transurethral resection of bladder tumor for non-muscle invasive bladder cancer (NMIBC). Intravesical instillation of bacillus Calmette-Guérin (BCG) is widely used to prevent recurrence and progression. There are two types of NMIBC: primary NMIBC and subsequent NMIBC after radical nephroureterectomy (RNU). We compared the clinical outcomes of BCG intravesical instillation therapy between the two types of NMIBC. Patients and Methods This study included a total of 357 patients, who received BCG intravesical instillation therapy to prevent recurrence of NMIBC (pTa/pT1) between 1991 and 2019. Among them, 34 patients had subsequent NMIBC after RNU and the remaining 323 patients had primary NMIBC. This retrospective study analyzed 68 patients extracted by propensity score matching. Survival curves were estimated using the Kaplan–Meier method, and independent prognostic factors for survival were examined by the Cox proportional hazards model. Results The 3-year recurrence-free survival (RFS) rates in patients with primary NMIBC and subsequent NMIBC after RNU were 70.7% and 54.8%, respectively (p = 0.036). However, there were no significant differences between the two groups in progression-free survival and cancer-specific survival. Multivariate analysis of RFS showed that only a previous history of upper tract urothelial carcinoma was an independent prognostic and predictive factor. Conclusion Patients with subsequent NMIBC after RNU treated with BCG intravesical instillation therapy have a higher risk of recurrence than those with primary NMIBC. Thus, stringent follow-up is necessary for patients with subsequent NMIBC after RNU.

The purpose of this study was to evaluate the effects of two different concentrations of silver diammine fluoride (SDF) on dentin bonding performance. Human mid-coronal dentin was treated with either distilled water (control), 3.8%SDF or 38%SDF for 3 min. A two-step self-etch adhesive and resin composite were applied according to manufacturer's instructions. After thermocycling (TC) at 0, 5,000 and 10,000 cycles, microtensile bond strength (µTBS) testing and morphological assessment of resin-dentin bonding interface were performed. At 0 TC, µTBSs of 3.8% and 38%SDF were significantly reduced (p

Objective: To investigate the relationship between clinicopathological findings and membranous CD155 (mCD155) or cytoplasmic CD155 (cCD155) expression in bladder cancer (BC). Methods: We retrospectively analyzed 103 patients with BC who underwent radical cystectomy between 1990 to 2015 at Kitasato University Hospital. Immunohistochemical staining was performed to evaluate CD155 expression in tumor cells. Cases with > 10% expression on the membrane or cytoplasm of tumor cells were positive. The Fisher′s exact test was used for categorical variables and the Kaplan–Meier method was used for survival outcomes. Univariate and multivariate Cox regression hazard models were used to evaluate the survival risk factors. Results: Cases that were mCD155-positive were associated with high-grade tumors (p = 0.02), nodal status (p < 0.01), and pT stage (p = 0.04). No association with any clinicopathological factor was observed in the cCD155 cases. Kaplan–Meier analysis showed that mCD155-positive cases had shorter periods of recurrence-free survival (p = 0.015) and cancer-specific survival (p = 0.005). Only nodal status was an independent predictor for both cancer-specific survival and recurrence-free survival in multivariate analysis (p = 0.02 and p < 0.01, respectively). Conclusion: mCD155 expression may be a marker of an aggressive phenotype and a poor prognosis in patients with BC.

This study investigated the influence of application/wash-out times of sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) on dentin bond strength of one-step self-etch adhesives (1-SEAs). Human coronal dentin discs with a standardized smear layer were pretreated with 6% NaOCl or 100 ppm HOCl for 5 s, 15 s, or 30 s, and washed out with water for 5 s, 15 s or 30 s with or without the application of Clearfil DC Activator (CDA). No pretreatment was used as a control. The discs were bonded with a 1-SEA (Bond Force II or Clearfil Universal Bond Quick) and microtensile bond strength (µTBS) was measured after 24 h. Pretreatment with NaOCl for 15 s and 30 s significantly decreased µTBS (p0.05), irrespective of wash-out time. The application of CDA recovered µTBS but did not outperform the control group. Conversely, pretreatment with HOCl for 15 s and 30 s followed by 30 s wash-out time significantly increased µTBS of 1-SEAs (p0.05), regardless of CDA application.

Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR 1.92; 95% CI 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

The effects of deproteinization using sodium hypochlorite (NaOCl) and the subsequent application of an antioxidant (sodium p-toluenesulfinate, STS) onto the bonding durability of universal adhesives on eroded dentin were investigated. Untreated sound dentin served as the control, whereas eroded dentin, which had been prepared by pH-cycling in 1% citric acid and a remineralization solution, was either untreated, deproteinized with a 10% NaOCl gel or deproteinized with the 10% NaOCl gel and subsequently treated with an STS-containing agent. The dentin surfaces were bonded using a universal adhesive (Clearfil Universal Bond Quick, Scotchbond Universal or G-Premio Bond), and the micro-tensile bond strength (µTBS) test was performed after 24 h or 10,000 thermal cycles. The µTBS data were statistically analyzed using a three-way ANOVA and Tukey’s HSD post hoc tests. The lowest µTBS was measured on untreated eroded dentin (p &lt, 0.001). Deproteinization of eroded dentin resulted in µTBS similar to untreated sound dentin (p &gt, 0.05), but the highest µTBS was obtained if deproteinization was followed by the application of STS. Thermocycling significantly decreased µTBS in all groups (p &lt, 0.001), except for STS-treated, deproteinized, eroded dentin (p &gt, 0.05). This indicated that deproteinization, followed by the application of STS, could enhance the bonding durability of universal adhesives on eroded dentin.

The adhesion of composite resin to caries-affected dentin differs from the adhesion of resin to sound dentin. We evaluated the bond strengths of dual-cure resin composites applied to caries-affected root canal dentin under various clinical conditions and using several caries removal indicators. In the dye stain 1 group, caries were removed to a pale pink stain level using a caries detector. In the dye stain 2 group, caries were removed to a stain-free level using a caries detector. In the probing group, caries were removed to the level of hardness based on probing with a sharp explorer. Additionally, a sound dentin group was used as a control. We compared the resin composite microtensile bond strengths and failure mode distribution among the groups. The bond strengths (MPa) of the probing (64.6 ± 11.9) and the sound dentin (68.7 ± 11.1) groups were significantly higher than those of the dye stain 1 (46.9 ± 7.9) and 2 (47.5 ± 8.4) groups (p < 0.05). The removal of caries-affected dentin using a dentin-hardness-based technique showed higher tensile strength than that using a dye stain technique involving removal to any color level. Thus, the caries removal technique used on root canal dentin affects the bond strength of the resin composite.

The purpose was to evaluate the effect of a hydrophilic amide monomer on μTBS of one-step adhesive to dentin at different application times. Clearfil Universal Bond Quick (UBQ), experimental adhesive (UBQexp; same compositions as UBQ but hydrophilic amide monomer was replaced with 2-hydroxyethyl methacrylate), Clearfil SE ONE and Clearfil SE Bond were applied to midcoronal dentin prepared with 600-grit SiC at different application time (0, 10, 20 and 40 s). Water sorption (Wsp) and the ultimate tensile strength (UTS) of polymerized adhesives were also measured. UBQ showed significantly lower Wsp and higher UTS than UBQexp. At each application time, UBQ exhibited significantly higher μTBSs than UBQexp. UBQ showed the highest μTBS at 0 s application time among all the adhesives. When the application time was prolonged from 0 s to 10 s, only UBQ showed no significant difference. The hydrophilic amide monomer increased μTBS with reduction in Wsp and increase in the UTS and may allow a shortened application time.

This study investigated the effect of fluoride mouthrinses on bonding of a one-step self-etch adhesive to bovine root dentin. Application of a NaF solution (0, 450, 900, or 9,000 ppm) to bovine root dentin surfaces was performed for 30 s (immediate) or before bonding of an all-in-one adhesive. Microtensile bond strength (µTBS) testing and scanning electron microscopic (SEM) observation of the acid-base resistance zone (ABRZ) were performed. µTBS values and calculated ABRZ areas were analyzed by using two-way ANOVA and the t-test with Bonferroni correction. The significance level was set at P = 0.05 (n = 30). Fracture mode was analyzed with the Mann-Whitney U test with Bonferroni correction. The significance level set at P = 0.00178 (n = 30). µTBS did not significantly differ between the control, 450 ppm F, and 900 ppm F specimens (P > 0.05) but was significantly lower in 9,000 ppm F specimens (P < 0.05). SEM showed a significant increase in acid resistance at the adhesive-dentin interface, including the ABRZ, after fluoride application.

Purpose The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients. Design Retrospective review of medical records. Subjects and setting The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014. Methods Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis. Results Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002). Conclusions Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

The receptor activator of NF-κB ligand (RANKL)-binding peptide, OP3-4, is known to stimulate bone morphogenetic protein (BMP)-2-induced bone formation, but peptides tend to aggregate and lose their bioactivity. Cholesterol-bearing pullulan (CHP) nanogel scaffold has been shown to prevent aggregation of peptides and to allow their sustained release and activity; however, the appropriate design of CHP nanogels to conduct local bone formation needs to be developed. In the present study, we investigated the osteoconductive capacity of a newly synthesized CHP nanogel, CHPA using OP3-4 and BMP-2. We also clarified the difference between perforated and nonperforated CHPA impregnated with the two signaling molecules. Thirty-six, five-week-old male BALB/c mice were used for the calvarial defect model. The mice were euthanized at 6 weeks postoperatively. A higher cortical bone mineral content and bone formation rate were observed in the perforated scaffold in comparison to the nonperforated scaffold, especially in the OP3-4/BMP-2 combination group. The degradation rate of scaffold material in the perforated OP3-4/BMP-2 combination group was lower than that in the nonperforated group. These data suggest that perforated CHPA nanogel could lead to local bone formation induced by OP3-4 and BMP–2 and clarified the appropriate degradation rate for inducing local bone formation when CHPA nanogels are designed to be perforated.

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I–V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.

This study aimed to assess the effects of a temporary sealing material and cleaning method of resin-coated dentin on the bond strength of computer-aided design/computer-aided manufacturing (CAD/CAM) inlay restorations. Resin-coated dentin surfaces were unsealed or temporarily sealed for 1 h or 1 week. For the temporarily sealed group, a hydraulic temporary sealing material was removed and further divided into four groups: without cleaning, cleaned with a rotational brush, a universal cleaner or an air-polishing device. Some specimens were investigated with energy dispersive X-ray spectroscopy and the others were used for microtensile bond strength (MTBS) test. A sealing material could not be removed with a rotational brush, which resulted in pretest failures in all specimens after 1 h and which resulted in low MTBS after 1 week. An air-polishing device can clean resin-coated dentin temporarily sealed with a hydraulic temporary sealing material and resulted in the similar MTBS as in the unsealed group.

The purpose of this study was to investigate the influence of phosphoric acid etching, metal primer or silane coupling agent application on dentin bonding performance of a 2-step self-etch adhesive system. Human dentin surfaces were prepared and divided into four groups depending on the pre-treatment method: no pretreatment (Clearfil SE Bond 2, CONTROL); 40% phosphoric acid (K-Etchant GEL, K); metal primer (Alloy Primer, AP); or silane coupling agent (Porcelain Bond Activator, PB). The specimens were sectioned into beams, separated into 2 subgroups (n=20): no thermocyling or thermocycled (TC), and subjected to a µTBS test and an acid-base challenge for SEM observation. Statistically lower results were observed between K and AP groups, PB and CONTROL, and PB with/without TC (p

Simple Summary Unfavorable results following radical cystectomy for bladder cancer (BCa) highlights a critical need for a novel prognostic molecular biomarker with potential therapeutic benefits. In the present study, the expression levels of AHNAK2 in specimens obtained by radical cystectomy were classified as “low expression” or “high expression” by immunohistochemical staining. Then, we retrospectively evaluated associations between the two AHNAK2 expression patterns and the prognoses in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS). Our multivariate analysis, adjusting for the effects of clinicopathological features, showed that the high expression level of AHNAK2 was an independent risk factor for RFS and CSS. The present study showed that AHNAK2 acts as a novel prognostic biomarker in patients with radical cystectomy for BCa. Abstract Data regarding expression levels of AHNAK2 in bladder cancer (BCa) have been very scarce. We retrospectively reviewed clinical data including clinicopathological features in 120 patients who underwent radical cystectomy (RC) for BCa. The expression levels of AHNAK2 in the specimens obtained by RC were classified as low expression (LE) or high expression (HE) by immunohistochemical staining. Statistical analyses were performed to compare associations between the two AHNAK2 expression patterns and the prognoses in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS). A Kaplan–Meier analysis showed that patients with HE had a significantly worse RFS and CSS than those with LE (hazard ratio [HR]: 1.78, 95% confidence interval [CI]: 1.02–2.98, p = 0.027 and HR: 1.91, 95% CI: 1.08–3.38, p = 0.023, respectively). In a multivariate analysis, independent risk factors for worse RFS and CSS were shown as HE (HR: 1.96, 95% CI: 1.08–3.53, p = 0.026 and HR: 2.22, 95% CI: 1.14–4.31, p = 0.019, respectively) and lymph node metastasis (HR: 2.04, 95% CI: 1.09–3.84, p = 0.026 and HR: 1.19, 95% CI: 1.25–4.97, p = 0.009, respectively). The present study showed that AHNAK2 acts as a novel prognostic biomarker in patients with RC for BCa.

This study evaluated the effect of temporary sealing materials and cleaning protocols on the bond strength of resin cement applied to dentin using resin-coating technique. Scotchbond Universal Adhesive and Filtek Supreme Ultra Flowable were applied to bovine dentin. Forty-five specimens were divided into the following three groups according to the temporary sealing materials: Cav-: CAVITON EX, Vas-: COCOA BUTTER and FIT SEAL, and Sep-: Washable SEP and FIT SEAL. Each material was placed on resin-coated dentin. After 1-week water storage, one of the following three cleaning protocols was performed: -WA: washed with water, -BR: brushed with PRESSAGE, and -AF: cleaned with AIR-FLOW. Microtensile bond strength test and EDS analysis were conducted. Irrespective of the cleaning protocol used, Washable SEP demonstrated less residual debris on resin-coated dentin, resulting in high bond strength. Regardless of the temporary sealing material applied, AIR-FLOW demonstrated less residual debris, resulting in high bond strength.

Purpose. The potential of UV-mediated photofunctionalization to enhance the resin-based luting agent bonding performance to aged materials was investigated. Methods. Sixty samples of each material were prepared. Yttria-stabilized zirconia (YZr) and Pd-Au alloy (Pd-Au) plates were fabricated and sandblasted. Lithium disilicate glass-ceramic (LDS) was CAD-CAM prepared and ground with #800 SiC paper. Half of the specimens were immersed in machine oil for 24 h to simulate the carbon adsorption. Then, all of the specimens (noncarbon- and carbon-adsorbed) were submitted to UV-mediated photofunctionalization with a 15 W UV-LED (265 nm, 300 mA, 7692 μW/cm2) for 0 (control groups), 5, and 15 min and subjected to contact angle (Ɵ) measurement and bonded using a resin cement (Panavia™ V5, Kuraray Noritake, Japan). The tensile bond strength (TBS) test was performed after 24 h. The Ɵ (°) and TBS (MPa) data were statistically analyzed using two-way ANOVA and Bonferroni correction tests ( α = 0.05 ). Results. In the carbon-adsorbed groups, UV-mediated photofunctionalization for 5 min significantly decreased Ɵ of all materials and increased TBS of YZr, and UV for 15 min significantly increased the TBS of LDS and Pd-Au. In noncarbon-adsorbed groups, UV-photofunctionalization did not significantly change the Ɵ or TBS except YZr specimens UV-photofunctionalized for 15 min. Conclusion. UV-mediated photofunctionalization might have removed the adsorbed hydrocarbon molecules from the materials’ surfaces and enhanced bond strengths of Panavia™ V5 to YZr, LDS, and Pd-Au. Additionally, UV-mediated photofunctionalization improved the overall TBS of YZr. Further investigation on the optimum conditions of UV photofunctionalization on indirect restorative materials should be conducted.

The overexpression of DJ-1 protein and its secretion into the bloodstream has been reported in various neoplasms. However, serum levels and the subcellular localization of DJ-1 have not been analyzed in detail in bladder cancer (BC). Our comprehensive analysis of these variables started with the measurement of DJ-1 in serum from 172 patients with BC, 20 patients with urolithiasis and 100 healthy participants. Next, an immunohistochemical study of DJ-1 expression and localization was conducted in 92 patients with BC, and associations with clinicopathologic factors and patient outcomes were evaluated. Serum DJ-1 was significantly higher in patients with BC than in those with urolithiasis or in healthy participants. Immunohistochemically, a cytoplasm-positive (Cy+) and nucleus-negative (N−) DJ-1 pattern was associated with age and pathologic stage. Log-rank tests indicated that the Cy+, N− pattern was significantly associated with overall survival (OS), recurrence-free survival (RFS), and cancer specific survival (CSS). In addition, the Cy+, N− pattern was an independent prognostic factor in the multivariate analysis adjusted for the effects of the clinicopathologic outcomes. The investigation of DJ-1 expression might help physicians to make decisions regarding further follow-up and additional treatments.

Background Data are scarce regarding intravesical maintenance therapy (MT) with the low-dose bacillus Calmette–Guérin (BCG) Tokyo strain. We investigated the efficacy and safety of MT with a half dose of the Tokyo strain for patients following transurethral resection of nonmuscle invasive bladder cancer (NMIBC). Methods This study retrospectively reviewed clinical data on 78 patients diagnosed with intermediate or high-risk NMIBC followed by either MT (n = 38) or IT alone (n = 40) between January 2012 and March 2018. Statistical analysis was performed to compare recurrence-free survival (RFS) and adverse effects between the two groups. BCG was instilled once weekly for 6 weeks as IT, then once weekly in 2-week for a total of 20 instillations over 3 years. Results Kaplan–Meier analyses showed that patients undergoing MT had significantly better RFS than did those undergoing IT alone (hazard ratio (HR):0.32, 95% confidence interval (CI):0.12–0.89, P = 0.02). The 3-year RFS was 65.0% in the IT group and 89.5% in the MT group. Multivariate analysis showed that MT was associated with a reduced risk of recurrence (HR: 0.32, 95% CI:0.11–0.93, P = 0.03). One MT patient (2.6%) exhibited progression. Conclusions The BCG Tokyo strain showed acceptable efficacy and safety in patients undergoing MT; thus, it is a potential treatment for preventing bladder cancer recurrence.

The effect of curing mode of dual-cure resin cements on the tensile bond strength (TBS) of universal adhesives to enamel, dentin, zirconia, lithium disilicate ceramics (LDS), feldspathic porcelain (FP), and a Pd-Au alloy was evaluated. The substrates were bonded using Tokuyama Universal Bond (TUB) or Scotchbond Universal Adhesive (SBU), followed by luting with Estecem II (ECII) or Rely-X Ultimate (RXU), respectively, which were used either in light-curing or self-curing mode. The TBS test was performed after 24 h or 5,000 thermal cycles. Light-curing significantly improved the 24-h TBS of TUB/ECII to enamel, dentin and FP, as well as the TBS of SBU/RXU to all substrates except LDS. After thermal cycling, light-curing significantly increased the TBS of both adhesives/cements to dentin, but significant differences between curing modes were seldom observed for other substrates. This suggested that light-curing is essential for the hydrophilic dentin, but self-curing might be sufficient for other substrates.

Background: Radical nephroureterectomy (RNU) is the standard treatment for patients with upper tract urothelial carcinoma (UTUC). However, approximately 25% of patients experience recurrence or metastasis after RNU. This study evaluated the clinical outcome and efficacy of salvage chemotherapy (SC) after recurrence or metastasis. Patients and Methods: Of the 441 nonmetastatic UTUC patients who underwent RNU, 147 patients with recurrent or metastatic lesions were analyzed; patients with bladder cancer recurrence were excluded. Time from disease recurrence or metastasis to cancer-specific survival (CSS) was estimated by the Kaplan-Meier method. Multivariate analyses were performed with the Cox proportional hazards regression model, controlling for the effects of clinicopathological factors. Results: The median time from RNU to disease recurrence or metastasis was 13.2 months. In the recurrent or metastatic sites, 31 cases (21%) were liver. In multivariate analyses, pT stage (≥pT3), time to recurrence (p < 0.001). Conclusion: Two or more risk factors defined the high-risk group for patients with recurrence or metastasis after RNU. SC was associated with improved survival in patients with high-risk UTUC.

The purpose of this study was to evaluate the bonding performance of carboxyl-based monomers in the priming agents to highly translucent zirconia. Highly translucent zirconia disk-shaped specimens of yttria-partially stabilized zirconia (Y-PSZ) (Katana HT zirconia) after sandblasting, were assigned to 5 groups according to the chemical pretreatment: no-treatment (Con), PZ Primer (PZP), PZ primer liquid A+MMA (PZA, as MDP primer), Super-Bond liquid (SBL, as 4-META primer) and experimental 5% 4-MET primer (MET). After priming, stainless steel rods were bonded to the zirconia specimens with TBB-initiated resin. The tensile bond strength test was performed after storage for 24 h, 30, and 150 days in 37°C water. The Weibull moduli decreased in all groups except PZA after 150 days. Superior bond strength observed in PZA and MET groups after aging. Application of carboxyl-based monomers were found to be effective in adhesion to highly translucent zirconia ceramics.

The effect of different air-blowing strategies using a prototype of a newly developed clinically applicable warm air-blowing device on the microtensile bond strength (μTBS) of one-step self-etch adhesives (1-SEAs) to human root-canal dentin was evaluated. Post cavities (8 mm depth, 1.5 mm diameter) were prepared and bonded with four 1-SEAs. Air-blowing was performed using normal air (23±1°C) for 10 or 20 s; warm air (60±1°C) for 10 or 20 s; or their combination for 10 s (5 s normal, 5 s warm) or 20 s (10 s normal, 10 s warm). After filling with corresponding core materials and 24-h water storage, μTBS test was performed. For three of the 1-SEAs, combined air-blowing for 20 s significantly increased μTBS compared to other air-blowing strategies (p

Background Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL. Conclusion Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.

Summary Objective The objective of this study was to investigate the histomorphometric changes around the site of mini-screw insertion in the regenerated bone which was induced by an anabolic-injection method using both anabolic peptide and bone morphogenetic protein 2 (BMP-2). Methods Twenty-seven eight-week-old C57BL/6J male mice were used. Some mice received submucosal co-injections of anabolic peptide and BMP-2 just in front of the maxillary first molar. Screw insertion was then performed 4 weeks after injection. All mice underwent a weekly in vivo micro-focal X-ray computed tomography (µCT) analysis before being sacrificed at week 8. The bone formation activity was evaluated using fluorescent labelling in the undecalcified sections. The analyses, including screw insertion, were performed in the frontal plane, in front of the site of screw insertion. Results Reconstructed µCT images revealed that the co-injection of anabolic reagents could lead to a gradual increase in the bone mineral density (BMD) of the injection-induced thickened bone by week 8. Both radiological and histomorphometric analyses indicated that screw insertion did not have any deleterious effects on either the BMD or the bone formation activity of the induced bone. Furthermore, the injection of anabolic reagents also led to an increase in the BMD of the underlying maxillary bone at the injection site. Conclusion Our histomorphometric analyses suggest that performing such anabolic injection to thicken bone could stimulate bone formation in the basal bone as well as in the induced bone. Similar augmentation of bone formation could be obtained even after subsequent screw insertion at the site of the induced bone.

Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P

The purpose of this study was to evaluate the effect of fluoride mouthrinses on dentin bonding performance of a two-step selfetch adhesive; Clearfil SE Bond. Bovine root dentin surface was treated with either 450, 900, or 9,000 ppm F solutions for 30 s (immediate), and continually treated for one month (one month) before the bonding procedures. Microtensile bond strength (µTBS) test and scanning electron microscopic (SEM) observation of the acid-base resistance zone (ABRZ) were performed. Chemical state of fluorine on dentin surface was analyzed by X-ray absorption fine structure (XAFS). The 450 and 900 ppm F fluoride mouthrinses did not influence the µTBS to dentin, while the 9,000 ppm F fluoride solution adversely affected the µTBSs. The fluoride application to dentin significantly enhanced acid resistance at the adhesive/dentin interface including the ABRZ. The XAFS analysis indicated different concentrations of fluoride might create different chemical compounds on the dentin surface, influencing the µTBS results.

The aim of this study was to evaluate how alumina-blasting pressure affects the bond strength of CAD/CAM resin blocks (CRBs) to bovine dentin using two different types of resin cements. CRB slices were divided into three groups by alumina-blasting pressure, namely, untreated and 0.1 MPa and 0.2 MPa, and further divided into three subgroups by combination of CRBs surface treatment and types of cement: Scotchbond Universal and RelyX ultimate (RXB), Scotchbond Universal and RelyX unicem2 (U2B), ceramic primer and RelyX unicem2 (U2C). The CRB slices were then cemented to bovine dentin, microtensile bond strength test was performed and evaluated. Regardless of the alumina-blasting pressure, RXB group have the highest µTBS and bond strength tends to increase with increasing alumina-blasting pressure. Alumina-blasting to CRB surface by at an appropriate pressure and use of conventional resin cement were required to obtain strong adhesion with the tooth structure.

This study aimed to develop an inventory for advance care planning implementation for persons with dementia in group homes and to examine the association between inventory implementation and residents’ quality of dying. A nationwide cross-sectional study was conducted via questionnaires mailed from 2000 group homes in Japan, selected through stratified random sampling. Participants were managers and care planners who had provided end-of-life care for recently deceased residents. The newly developed inventory was used to assess advance care planning implementation for persons with dementia, and the Quality of Dying in Long-term Care Scale was used to evaluate quality of dying. The valid response rate was 28.5% (n = 569). The factor structure of the newly developed Advance Care Planning Practice Inventory and the association between its implementation and quality of dying were verified using factor analysis and internal consistency, and logistic regression, respectively. The composite score and the factor score of the newly developed inventory were significantly associated with quality of dying (p < 0.05). The implementation of advance care planning improves the quality of dying. These findings can be used in development of educational programs, as well as research on advance care planning for care providers.

The purpose of this study was to evaluate the effect of one week of Computer-aided design/Computer-aided manufacturing (CAD/CAM) crown storage on the μTBS between resin cement and CAD/CAM resin composite blocks. The micro-tensile bond strength (μTBS) test groups were divided into 4 conditions. There are two types of CAD/CAM resin composite blocks, namely A block and P block (KATANA Avencia Block and KATANA Avencia P Block, Kuraray Noritake Dental, Tokyo, Japan) and two types of resin cements. Additionally, there are two curing methods (light cure and chemical cure) prior to the μTBS test—Immediate: cementation was performed immediately; Delay: cementation was conducted after one week of storage in air under laboratory conditions. The effect of Immediate and Delayed cementations were evaluated by a μTBS test, surface roughness measurements, light intensity measurements, water sorption measurements and Scanning electron microscope/Energy dispersive X-ray spectrometry (SEM/EDS) analysis. From the results of the μTBS test, we found that Delayed cementation showed significantly lower bond strength than that of Immediate cementation for both resin cements and both curing methods using A block. There was no significant difference between the two types of resin cements or two curing methods. Furthermore, water sorption of A block was significantly higher than that of P block. Within the limitations of this study, alumina air abrasion of CAD/CAM resin composite restorations should be performed immediately before bonding at the chairside to minimize the effect of humidity on bonding.